Hypertension is the leading global preventable risk factor for cardiovascular disease and premature death.1 In 2025, the estimated global prevalence of hypertension will be 29%.2 In Hong Kong, around 27% of the population suffers from hypertension, with around half being unaware of their condition.3 Education is an important socioeconomic indicator of hypertension.4 Researchers from The Jockey Club School of Public Health and Primary Care at The Chinese University of Hong Kong examined the gender-specific trends of educational inequality in hypertension between 1999 and 2014 in Hong Kong and found widening educational inequality in females from 1999 to 2009 that continued to persist thereafter.4 The results were published in Nature Scientific Reports.
Education has been considered the most important socioeconomic indicator of hypertension, as it reflects the cognitive functioning of an individual to respond to health information, and is an upstream indicator of future employment and income.4 Differential diffusion of health information could exacerbate social inequalities in health due to divides in terms of knowledge and information-seeking behaviors across education groups.4 There were no studies in Asia investigating the gender-specific trends of educational inequality in hypertension before, Chung et al. therefore conducted a serial cross-sectional study, using population-representative data from eight territory-wide cross-sectional household surveys, to examine these trends between 1999 and 2014 in Hong Kong.4
The surveys collected health-related data including health status, healthcare utilization and hospitalization, medical benefits and insurance, as well as sociodemographic and socioeconomic characteristics.4 They hypothesized that the inequality in hypertension across education levels in Hong Kong would have widened over time, and would be more apparent in women.4 A total sample of 97,481 subjects aged 45 years or above was included for the analysis.4
An increase in age-standardized prevalence of hypertension was observed in both genders between 1999 and 2014.4 A surge of hypertension in females differed across education levels, but not across household income levels, was observed until 2009.4 The increase in hypertension prevalence was more apparent in less educated women, but this prevalence among women remained stable across all education groups after 2009.4 This differential increase by education level was not observed in males.4 Relative index of inequality in female increased from 1.01 (95% CI: 0.77-1.33) to 1.48 (95% CI: 1.28-1.72) between 1999 and 2014, with a peak in 2009.4
The rising trend in physician-diagnosed hypertension in Hong Kong could have partially been driven by increased health awareness and detection over time, along with a number of local health education programs in the community, and earlier and more proactive detection in the primary cancer setting.4 The emergence of digital media since 2000 and its resulted digital divides across social groups could also explain the observed gender-specific widening trends between 1999 and 2009, since the prevention of hypertension depends largely on health information and lifestyle habits.4
The widened and persistent discrepancy across education levels is apparent among women in Hong Kong.4 Less educated, but not necessarily income poor, women would be expected to have greater cardiovascular disease burden in the coming years and could serve as a potential target segment for specific interventions in Hong Kong.4 Designing health messages appropriate to the literacy level of the less educated may be more conducive to favorable behavioural changes so as to reduce the prevalence of hypertension, and policy makers should be made aware of this inequality when designing the hypertension prevention strategies.4
1. Bundy JD, He J. Hypertension and Related Cardiovascular Disease Burden in China. Annals of Global Health. 2016;82(2):227-233.
2. Veisani Y et al. The role of socio-economic inequality in the prevalence of hypertension in adults. J Cardiovasc Thorac Res. 2019;11(2):116-120.
3. Griffiths S. Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings. Task Force on Conceptual Model and Preventive Protocols; 2018:89. pco.gov.hk/english/resource/files/RF_HT_full.pdf. Accessed October 16, 2019.
4. Chung GKK et al. Educational inequality in physician-diagnosed hypertension widened and persisted among women from 1999 to 2014 in Hong Kong. Sci Rep. 2019;9(1):14361.